Provider Demographics
NPI:1326127325
Name:LUCK, ANDREW S (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:LUCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3079 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1041
Mailing Address - Country:US
Mailing Address - Phone:315-866-4020
Mailing Address - Fax:315-866-4026
Practice Address - Street 1:3079 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350
Practice Address - Country:US
Practice Address - Phone:315-866-4020
Practice Address - Fax:315-866-4026
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0038951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0010942OtherRHSCO
5950L5OtherMVP
161606726LUIOtherBCBS
10069694OtherCDPHP
161606726LUIOtherBCBS
T26701Medicare UPIN